What Are the Pros and Cons of an Anterior Hip Replacement?

What Are the Pros and Cons of an Anterior Hip Replacement?

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When nonsurgical treatments fail, hip replacement surgery can be an effective option for relieving pain and restoring mobility in adults with hip damage. Whether you need a hip replacement after a fall or to repair hip joints after years of arthritis, surgery helps many adults return to an active life, free of pain. 


And, hip replacement surgery has significantly improved over the years. Many patients are candidates for minimally invasive hip replacements, which typically result in smaller incisions, less pain, and shorter recovery times. We also continue finding new approaches to performing hip replacements, with the direct anterior approach rising in popularity. If you’re considering a hip replacement, understanding the benefits and drawbacks of your options can help you to make the best decision in partnership with your surgeon.


#HipReplacement surgery is safe and effective at relieving pain and restoring mobility. On the #MedStarBlog, fellowship-trained hip specialist Dr. Kenneth Vaz explains the pros and cons of the anterior approach, a surgical technique rising in popularity: https://bit.ly/3tyX5DB.
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How is the anterior approach to hip replacement different from the posterior approach?

There is no perfect surgery, which is why we’re always looking for new ways to make hip replacements easier and more successful for patients. The most common approaches to accessing the hip joint are:


  • The posterior approach, which involves an incision on the side of the thigh
  • The anterior approach, which accesses the hip closer towards the front of the thigh

The name for the approach does not necessarily describe where the incision is as much as it does how your surgeon accesses your hip relative to the most important muscles for hip function, the abductor muscles. Neither approach involves cutting the abductor muscles near the hip joint, which makes recovery easier and less painful for patients. And, both approaches allow skilled surgeons to minimize the risk of future hip dislocation.


Today, there is some debate over which approach is better, but the truth is that neither is the “best” option for all. Both approaches are safe and effective, with advantages and disadvantages. A skilled hip surgeon will recommend the best approach for you based on their surgical preference and your anatomy, body type, and medical history. 


There are some factors that may deter a surgeon from using an anterior approach for certain patients. For example, patients who are overweight or have a stomach that hangs down may have a harder time with wound recovery because of the location of the incision. For that reason, your surgeon may recommend a posterior approach.


What are the benefits of an anterior approach?

The anterior approach proves to be a promising option with various advantages over other approaches, including:


Less pain: Since surgeons can access the hip joint without cutting muscles using the anterior approach, research suggests that patients may experience less pain as they begin walking in the days after recovery. The most rigorous study showed that patients who underwent a hip replacement using an anterior approach gave up a walking aid, like a crutch or cane, one week earlier than those who received a hip replacement using the posterior approach. 


Better precision: Because patients are laying on their back instead of their side, we can use a type of live x-ray imaging called fluoroscopy. This allows us to place the implants in real-time with greater precision. Better placement can minimize the chances of the artificial joint wearing out over time, dislocation, or discomfort due to differences in leg lengths.


What are the risks of an anterior approach?

Hip replacements are incredibly safe. But, like all surgical procedures, there is always a chance that something unexpected could happen. One of the risks involved with using the anterior approach is the potential for a crack in the thigh bone or change in the implant position in relation to the thigh bone. However, the risk is still low, occurring in less than two percent of patients who undergo this approach.


In addition, it’s not uncommon to have some numbness in the skin on the front of the thigh. Most people don’t notice it after a few weeks. In rare cases, damage to a nearby nerve can lead to a persistent tingling or burning, called neuritis.


Recovery after an anterior hip replacement.

An anterior approach to hip replacement surgery is an outpatient procedure that lasts about one to two hours. Provided there are no complications, you can walk on it the same day of surgery with the help of our physical therapists. Some patients are discharged the same day depending on how well they’re getting around. If you are a candidate for same-day surgery, you should have a family member or friend drive you home and stick around in case you need an extra hand. 


You may be more sore the day following surgery, but we’ll help to proactively manage your pain. A walker will help you to get around while minimizing the risk of fall as you regain your balance and strength. Whether you undergo a hip replacement using an anterior or posterior approach, we encourage you to walk and attend physical therapy as this will help with recovery.


What to look for when choosing a hip surgeon.

Research shows that surgeons who perform a high number of specialized procedures generate better results for their patients. At MedStar Health, our orthopedic experts have specialty training in hip and knee surgery. Because we focus exclusively on hip and knee replacements, you can expect the best outcome whether your surgeon recommends an anterior or posterior approach. We take into consideration what will work best for your anatomy and recommend an approach that will lead to the best outcome for you. 


A hip replacement can dramatically transform your life for the better, so if hip pain is interfering with your quality of life, our hip specialists can help.


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